Theoretical foundations of a Starling-like controller for rotary blood pumps

Salamonsen, Robert Francis, Lim, Einly, Gaddum, Nicholas, AlOmari, Abdul-Hakeem H., Gregory, Shaun David, Stevens, Michael, Mason, David Glen, Fraser, John F., Timms, Daniel, Karunanithi, Mohan K. and Lovell, Nigel Hamilton (2012) Theoretical foundations of a Starling-like controller for rotary blood pumps. Artificial Organs, 36 9: 787-796. doi:10.1111/j.1525-1594.2012.01457.x

Author Salamonsen, Robert Francis
Lim, Einly
Gaddum, Nicholas
AlOmari, Abdul-Hakeem H.
Gregory, Shaun David
Stevens, Michael
Mason, David Glen
Fraser, John F.
Timms, Daniel
Karunanithi, Mohan K.
Lovell, Nigel Hamilton
Total Author Count Override 11
Title Theoretical foundations of a Starling-like controller for rotary blood pumps
Journal name Artificial Organs   Check publisher's open access policy
ISSN 0160-564X
Publication date 2012-09
Sub-type Article (original research)
DOI 10.1111/j.1525-1594.2012.01457.x
Volume 36
Issue 9
Start page 787
End page 796
Total pages 10
Place of publication Hoboken, NJ, United States
Publisher Wiley-Blackwell Publishing
Collection year 2013
Language eng
Formatted abstract
A clinically intuitive physiologic controller is desired to improve the interaction between implantable rotary blood pumps and the cardiovascular system. This controller should restore the Starling mechanism of the heart, thus preventing overpumping and underpumping scenarios plaguing their implementation. A linear Starling-like controller for pump flow which emulated the response of the natural left ventricle (LV) to changes in preload was then derived using pump flow pulsatility as the feedback variable. The controller could also adapt the control line gradient to accommodate longer-term changes in cardiovascular parameters, most importantly LV contractility which caused flow pulsatility to move outside predefined limits. To justify the choice of flow pulsatility, four different pulsatility measures (pump flow, speed, current, and pump head pressure) were investigated as possible surrogates for LV stroke work. Simulations using a validated numerical model were used to examine the relationships between LV stroke work and these measures. All were approximately linear (r2 (mean ± SD) = 0.989 ± 0.013, n = 30) between the limits of ventricular suction and opening of the aortic valve. After aortic valve opening, the four measures differed greatly in sensitivity to further increases in LV stroke work. Pump flow pulsatility showed more correspondence with changes in LV stroke work before and after opening of the aortic valve and was least affected by changes in the LV and right ventricular (RV) contractility, blood volume, peripheral vascular resistance, and heart rate. The system (flow pulsatility) response to primary changes in pump flow was then demonstrated to be appropriate for stable control of the circulation. As medical practitioners have an instinctive understanding of the Starling curve, which is central to the synchronization of LV and RV outputs, the intuitiveness of the proposed Starling-like controller will promote acceptance and enable rational integration into patterns of hemodynamic management.
Keyword Left ventricular assist device
Implantable rotary blood pump
Heart failure
Physiological control
Starling mechanism
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Information Technology and Electrical Engineering Publications
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 12 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 13 times in Scopus Article | Citations
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